5062 (SFD)77.� � --
C17? 19
a QtN 4
Building P.O. BOX 1504 No. 05062
Address 54-293 2averness 105 CALLE EST
LAOUINTA CALFORNpIA92253
Owner ..
13e COAlD8E7
Matling
Address
42-600 COOk St., Suite 200
City Zip Tel.
Pala Desert 1 92260 1 568-28
State UC.
g Classif. 288130 uct 328
Arch., Engr.,
Designer
Address
City Zip State
Lic. M
IL�L�NSED CONTRACTOR'S DECLARATION
atflrm that I am licensed under provisions of Chapter 9 (commencing with Section
eff�eeL� 3 0l the Business and Professions Code. and my license Is In full force and
snGNAnhM )
nATE . .
OWNEIiBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law la the follow)
reasort (Sec. 7031.5.Btatwu and pcyessions Cods: Any ray or awry-
erch b MM requires
Permit ccl b arer, 'Pro". do oft or repair any atnschss. talar to fs 4ssuance a w
me po't's'' Cantraetor3 License I—. Chapter atwameR that he is scarred prrmmw to
O islon 3 d the Bumf ress and p W"sion, Code. �O a he is 8.0"Wp wan Section 7000( o/
' rhe ZZ ,. -M Ary vrotaten of Section 7031.5 ,Aero% � . basis
s�4edi tine avpicant b a d►r p,naey Of not more roar fire hunted dollars (5300).
O 1. as owner of the Properly. or my employees with wages as their sole compensation, will
do the wornand the structure is not Intended or offered for sale. (Sec. 7044. &AWW ss and
Prolesaiors Godo: The C "eacto', License Law does not apply to an owner of
�PprtPey woo
Dutss or
on— 0*— ds ata -0 does suwork hirnsair or IhMWh ftown errpbyees.
,1"ld°d that such k'o— am not Mended or offered for rale. r, however, rhe h urs
Of srF"WWerr is sold wdhir one yaw d coupledw. the owna-busder r4 ham the burden
Of PMWV that he 60 not txJd or irprore for the purpose of $at.)
C 1, as owner of the Properly. am exclusively contracting with licensed contractors to con•
struCt the project (Sec. 7044. Busrress and Professions Code: The Comractors License Law
es
dogar appy toan owner dop
property wt busds or Urproves 'thereon, and who cordrecfa for
such PM08C s wth a oortracbr(s) scersed pursuant to the Contractor -8 License Lar.)
O f am exempt under Sem R d P.C. for this reason
Date Owner
WORKERS COMPENSATION DECLARATION
I ,hereby affirm that I have a certificate of consent to sell -insure. or a certificate of
Wodujra Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
O COP)' is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed Jr the Perrot is for one hundred d lays (f 100) valuation
or Jan.)
I certify that in the performance of the work for which this permit Is Issued, I shall not
emplLaws o any person nn any manner so as to become subject to the workers' Compensation
Laws
of Calilomia
Date —Owner
NOTOE- TO APPLCAW. If. after malting this Cemdicare of Exemption you should become
sr4ed to rhe tMwkers' Corrpensaaon provmons of rhe Labor Code. you must bmhnrph
co' PiV wth such Wmis ww or OMs Penh shat be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, CW Code.)
Lenders Name
Lenders Address
This Is a building Permit when property filled out signed and validated, and Is subject to
expiration it work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above Information Is correct
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above.
mentioned properly for inspection purposes.
Signature of applicant
Gate
Mailing Address -
city, state, Zip
TYPE CONST. OCC. GRP.
A.P. Number PGA Neat — Phase 40A
Legal Description
Description_ Plan 3C8
sq. F1. 1627
No. Dw.
New O Add O Alter O Repair O Demolition O
stimated Valuation
$113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
4 A
Const.
468.00
Mech.
14.00
Electrical
67.41
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
$2,558,86 1,279.43
TOTAL
U-124 74_
REMARKS
--
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
12
Issued : /27/IP
Y Date ermit
Validated by:
Validation:
NO. ELECTRICAL FEES*
NO.
UNITS PLUMBING FEES
� ��•
YARD SPKLR SYSTEM
77
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
SIGN
WASH
ER(AUTOXDIS►q
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
CONSTRUCTION ESTIMATE
GRADING
cu. yd.
$ plus xi __
LUMBER GR.
N' t
'w
SO. FT.
sNo FL
SO. FT.
COMPRESSOR
FT.
poetSO.
GAS
SO. FT.
CAR F.
SO. FT.
WALL
SO. FT. @
NUITINO SYSTEM FORCED
SO. FT.
ESTIMATED CONSTRUCTION VALUATION Is
SPARK ARRESTOR
NOTE: Not to be used as property tax valuation
GAA FIREWALL
MECHANICAL FEES
YENTSYSTEM
FAN EVARCOOL HOOD
APPLUINC[
DRYER
/URNACE UNIT
WALL FLOOR SUSPENDED
MR HANDLJNG UNIT
CFM
NO. ELECTRICAL FEES*
NO.
UNITS PLUMBING FEES
� ��•
YARD SPKLR SYSTEM
77
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
SIGN
WASH
ER(AUTOXDIS►q
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
GRADING
cu. yd.
$ plus xi __
LUMBER GR.
FINAL INSP.
MING G
WATER CLOSET'
COMPRESSOR
HPPOLE,TEM/PERM
/'�
� 0,00-' (/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
LAVATORY
NUITINO SYSTEM FORCED
GRAVITY
AMPERES SERV ENT
SPARK ARRESTOR
GAA FIREWALL
SHOWER
I1104m B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX NEATER OUTPUT, B.T.U-
SO. FT. RESID g 14. c
SEWAGE DISPOSAL
SO.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
_
PERMIT FEE
p� TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEE CONST. FEE
ELECT. FEE
SMI FEE PLUMB. FEE;
STRUCTURE
PLUMBING
ELECTRICAL
HEATING d AIR CONp,
SOLAR
BACK
ND PLUMBING
UNDERGROUND
A.C. UNIT
LOLL AREA
B GRADE (�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FOAMSEWER
OR SEPTIC'Y027
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP,
STEEL
_
AS (FINAL) TEMP. POLE
GROUT
WATER HEATER
ICE v
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xi __
LUMBER GR.
FINAL INSP.
MING G
FINAL INSP.
ROOFING
/'�
� 0,00-' (/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAA FIREWALL
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
GARDEN WA--